Submitting a request for Equipment of Home Modification

Please complete and return the relevant form to us:

• Equipment Request Form (DOCX 180.2 KB)
• Home Modifications Request and Agreement Form (DOCX 97.2 KB)

Alternatively, once a client is eligible for the ACC funding stream, therapists can raise Category 1 requests directly on the ALTER portal.

Along with the equipment or home modification request form, all Category 2 items must also be submitted with:

• Delegate Approval Request Form (DOCX 57.9 KB)
• Risk Rating and Priority Scoring Form (DOCX 65.3 KB), or for Communication devices Priority Scoring Communication and Assistive Technology (DOC 170.5 KB)

An additional specification form may be needed if measurements or adjustments to the item need to be detailed.

• Checklist For Assessors Submitting Equipment Requests (DOCX 78.1 KB)
• Checklist For Assessors Submitting Home Modification Requests (DOCX 78.3 KB)

Please note that complex, customised equipment items will require an Equipment selection agreement form   (DOCX 61.0 KB) to be completed by the client and referring therapist, once delegate approval for the item has been approved.